Facial Scars and Keloids

Dr. Niamtu employs the latest technology to assist with the cosmetic treatment of facial scars. These include scars from trauma such as automobile accidents, cuts and lacerations as well as scars from surgical procedures performed on the face.

The advent of ultrapulse CO2 laser resurfacing has enabled a simple treatment for many scars. Most scars can be improved or totally eliminated with the Ultrapulse laser. This procedure takes only several minutes and is usually performed with local anesthesia. The scarred area is treated with the laser which causes a flattening of the scar borders and the formation of collagen in the skin. The result is a flatter and better blended scar. Some scars can be totally treated with a single laser session while most require a follow up laser procedure. Generally patients wait 90 days between treatments.

Many surgeons suggest waiting a full year before revising a scar. The contemporary literature as well as research performed by Dr. Niamtu show that better results are obtained by lasering scars early. By lasering scars as early as eight weeks, better results are obtained. In addition, the patient does not need to go a full year with an unsightly scar.

The examples in the floating Mona Lisa gallery on the right side of the page show treatment of traumatic scars. Each was treated by single or multiple sessions of CO2 ultrapulse laser resurfacing.

Lumenis Deep FX is a new type of "Fraxel" or fractional laser resurfacing that shows great promise for facial scars including burn and acne scars.

How does the laser treat the scar?

The CO2 laser can precisely remove scar tissue in layers as thin as a human hair.  By removing the diseased scar tissue the scar is reduced and shrinks.  In addition, the laser is also used to blend the junction of the scar and normal tissue.  Minor scars may respond to a single laser treatment while bigger scar may require multiple CO2 laser treatments.  These procedures are generally performed with local anesthesia and only take several minutes.  The healing is from 1-2 weeks and the treated area may remain pink for a while but can be covered with make up.

This patient is shown with an unfavorable scar from brow surgery (top picture).  The middle picture shows the scar immediately after CO2 laser treatment and the bottom picture shows the patient one month later

The above patient received this scar from an automobile accident.  Dr. Niamtu treated the scar with a single treatment of CO2 laser.  A response such as above is unusual for a single treatment and most similar scars may take several laser treatments.

Surgical Treatment of Scars

Although many scars can be treated with laser only, some scars need surgical revision as well as laser smoothing.  The images below show a hypertrophic scar of the bridge of the nose (A).  Concave areas tend to scar worse.  This scar was treated with a "Z-Plasty" technique where the thickened portion of the scar was incised and the flaps were transposed to remove tension from the wound (B, C).  Several laser treatments were then performed over the next several months.  The final result is shown in picture D.

The image below shows a patient with severe cystic acne scarring.  The deep scars at the corner of the mouth are too deep to simply laser, so they are excised and resutured to make them shallower.  The suture line can then be treated with the CO2 laser.  The picture on the right hand side shows the result after surgical scar excision and CO2 laser resurfacing.

Surgical Treatment of Keloid Scars

Keloid scar removal can be very challenging and it is impossible to promise a patient that the scar will be permanently removed and not return, but newer advances in keloid removal have been very promising for long term success. Larger keloid scars require surgical excision and can also be followed up by a single radiation treatment on the day of surgery. The combination of surgical excision and radiation has proven extremely effective in preventing reoccurrence of keloid scars. The following keloid scars were treated with both surgery and a single radiation treatment and the growths have not returned.

Non Laser Scar Treatment

Some scars may be treated without surgery by the injection of various medications. The following keloid scars were treated with multiple injections and no surgery or laser was required.

click to enlarge

The above patient sustained a dog bite and was treated with plastic incision closure by Dr. Niamtu

This keloid scar was treated first with injections then with radiowave excision.
The after picture is 3 months after treatment.